Provider Demographics
NPI:1457426157
Name:DEVINCENTIS, ROSALINDA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ROSALINDA
Middle Name:
Last Name:DEVINCENTIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:ROSALINDA
Other - Middle Name:G
Other - Last Name:TE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN
Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-386-7679
Practice Address - Street 1:305 N KEENE ST STE 107
Practice Address - Street 2:BOONE SURGERY CENTER
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6897
Practice Address - Country:US
Practice Address - Phone:636-386-9224
Practice Address - Fax:636-386-7679
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO064294367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered